Timing of treatment for nonneutropenic patients colonized with Candida

There has been a continuing evolution of the clinical spectrum of Candida infection in nonneutropenic patients. With better understanding of the predisposing factors for fungemia in critically ill patients, interest now centers on indications for early therapy, prior to the progression of colonization to fungemia. Recent prospective trials have identified persistence of Candida species in repetitive cultures of various sites as an essential if not necessary precursor for fungemia. Treatment for patients requiring prolonged intensive-care-unit residence and demonstrating colonization with Candida is suggested, based on the frequency with which such patients progress to fungemia. The efficacy of such treatment is undocumented, and clinical trials of various regimens of polyene or azole antifungals is needed.